Dear Obstetric Shared Care GPs,

Connecting you with the news you need for GP obstetric shared care. Pregnant? Getting Vaccinated is still recommended

Following the opening of the South Australian borders, there is expected to be some community transmission of COVID-19, and during the early phase of 2022 this will likely be the delta variant. COVID-19 in pregnancy will pose multiple challenges for the South Australian community. We want to minimise risk to our pregnant women and advocate for vaccination for pregnant women.

The GP Obstetric Shared Care Program therefore, considers that there are no risks – actual or theoretical – that would outweigh the potential benefits of vaccination for pregnant women and supports offering COVID-19 vaccination to pregnant and breastfeeding women.

Increased Risk for Severe Illness from COVID-19

Although the overall risks are low, people who are pregnant or recently pregnant, are at an increased risk for severe illness from COVID-19 compared with people who are not pregnant. Severe illness includes illness that requires hospitalisation, intensive care, need for a ventilator or special equipment to breathe, or illness that results in death. Additionally, people who have COVID-19 during pregnancy are at increased risk of preterm birth and stillbirth and might be at increased risk of other pregnancy complications.

Despite questions of efficacy with regard to Omnicron, it’s important to continue to encourge patients to get their boosters.

We do know that COVID-19 infection in pregnancy poses a significant risk for mothers and their babies, RANZCOG recommends that pregnant women receive booster vaccinations in line with the recommendations for the non-pregnant adult population.

Every news headline. Conversations with friends. The global SARS-CoV-2 pandemic and management of COVID-19 continues to dominate our world, and the pipeline of research to testing to practice has never been as visible to the public and professionals alike.

We hope that the following resources and links will assist you in the conversation about COVID-19 vaccination in pregnancy that you will have with your patients. We know that vaccination rates in pregnant South Australians is low, and we need to do all we can to raise those numbers.

As soon as further information comes to hand from SA Health, we will provide this to you.

CLICK HERE TO START 

What You Need to Know
Useful Information to Share with Your Patients

  • People who are pregnant or recently pregnant are more likely to get severely ill with COVID-19 compared with people who are not pregnant.
  • Getting a COVID-19 vaccine can help protect severe illness from COVID-19.
  • COVID-19 vaccination is recommended for people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future.
  • People who are pregnant may receive a COVID-19 vaccine booster shot.
  • Evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy has been growing. These data suggest that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy.
  • There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems in women or men.
  • COVID-19 vaccines do not cause COVID-19 infection, including in people who are pregnant or their babies.None of the COVID-19 vaccines contain live virus and cannot make anyone sick with COVID-19, including people who are pregnant or their babies.
  • Scientists and researchers have not found an increased risk for miscarriage among people who received an mRNA COVID-19 vaccine just before and during early pregnancy (before 20 weeks of pregnancy).
  • Vaccination during pregnancy builds antibodies that might protect the baby. When people receive an mRNA COVID-19 vaccine during pregnancy, their bodies build antibodies against COVID-19, similar to people who are not pregnant. Antibodies made after a pregnant person received an mRNA COVID-19 vaccine were found in umbilical cord blood. This means COVID-19 vaccination during pregnancy might help protect babies against COVID-19. More data are needed to determine how these antibodies, similar to those produced with other vaccines, may provide protection to the baby.

The Clinical Guidance on use of COVID-19 Vaccine in Australia (ATAGI) deem pregnant women as a priority group for vaccination and recommend they are routinely offered the Pfizer vaccine at any stage of pregnancy.
 
References:

Pregnant women are a priority group for COVID-19 vaccination and should be routinely offered Pfizer mRNA vaccine (Cominarty) or Spikevax (Moderna) at any stage of pregnancy. 

Talking COVID-19 Vaccines Information for Women

Many of you have asked for links to COVID-19 Vaccination in pregnancy videos:

  1. COVID vaccination in pregnancy
  2. How do mRNA vaccines work

Links to download PDFs of slides can also be found here.

Password for all videos – Twilight

Vaccination Exemptions


Some people are required to be vaccinated against COVID-19 under a relevant Emergency Management Act 2004 direction as a condition of their employment. A person must meet certain eligibility requirements in order to apply for an exemption.
 

Exemptions are limited to the below circumstances:

  • the person has a medical certificate or letter from a legally qualified medical practitioner certifying that the person:
    • has a medical exemption from receiving a TGA approved COVID-19 vaccine on either a permanent or temporary basis in accordance with the guidelines published by ATAGI; or
    • has a medical exemption on either a permanent or temporary basis from receiving the preferred vaccine as recommended by ATAGI for the person’s age; or
    • has an appointment to be assessed by a medical specialist or has commenced an assessment with a medical specialist to determine whether they have a medical exemption from receiving a COVID-19 vaccine on either a permanent or temporary basis in accordance with the guidelines published by ATAGI; or
    • is currently taking part in a COVID-19 vaccine trial that has regulatory approval and a confirmed start date for participation and receipt of a TGA approved vaccine would impact the validity of the trial.

The certificate or letter must clearly outline the reason for the exemption and which direction applies to their employment. The Chief Public Health Officer or her delegate must endorse the exemption.

  1. You will need to get a medical certificate from a qualified medical practitioner that clearly outlines the reason for an exemption in line with the Australian Technical Advisory Group on Immunisation (ATAGI) guideline: www.health.gov.au/resources/publications/atagi-expanded-guidance-on-temporary-medical-exemptions-for-covid-19-vaccines
  2. Your medical practitioner must complete an SA Health Chief Public Health Officer Immunisation Exemption Application Form.
  3. Submit your completed form and medical certificate to Health.NJNPExemptions@sa.gov.au.
  4. Your application for an exemption must be approved by the Chief Public Health Officer (CPHO). If approved, the CPHO will provide a signed exemption letter that can be provided to the RACF.

COVID-19 Primary Care Update 7/12/21

COVID-19 Acute Care and Regional Response Strategies

As part of the preparation to manage the next phase of the COVID-19 response, SA Health has released the COVID-19 Acute Care Response Strategy and COVID-19 Regional Response Strategy.

SA Health’s Acute Care Response Strategy sits alongside the Primary Care Response Strategy (released on 16 November 2021), and outlines pathways for adults, children and adolescents and pregnant women and neonates, including preparation, decanting, patient flow and response phasing.

The Regional Response Strategy spans across the Acute Care and Primary Care Response Strategies supports an integrated approach to managing COVID-19 in regional, rural and remote areas inclusive of primary care, community health services, in-home care and incorporates the care response for the Aboriginal population.

Publications

Here we describe a paper published in JAMA that reports the efficacy of the vaccination in reducing the risk of catching COVID-19 among pregnant women. It works!
 
We hope you find this interesting reading!
Does Pfizer vaccination reduce COVID-19 infection among pregnant women?
 
Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women. Goldshtein et al. JAMA.  July 2021
 

(Review also authored by Dr Hannah Gordon, Mercy Hospital for Women)
 
In Australia, women at any stage of pregnant are now eligible for the BNT162b2 (Pfizer-BioNTech) vaccine. However, pregnant women were originally excluded from RCTs assessing the safety and efficacy of COVID-19 trials. Thus, until now it has not been clear whether pregnancy women benefit from vaccination in the same way as the general population.

  • This retrospective cohort study from Israel included 7530 Pfizer-vaccinated pregnant women, matched with 7530 unvaccinated pregnant women, and investigated COVID-19 infection at 28 days or more following first dose of vaccine.
  • During the median follow up of 37 days (range 0 – 70 days), there were 118 (1.6%) COVID-19 infections within the vaccinated group vs 202 (2.7%) in the unvaccinated group.
  • A greater benefit of vaccination was found 28 days post vaccination (primary outcome), with 10 COVID-19 infections within the vaccinated group and 46 in the unvaccinated group after this time (28 – 70 days post). This gave an adjusted hazard ratio of 0.22 (95% CI, 0.11-0.43) and a vaccine efficacy of 78%.
  • Most Covid-affected participants were symptomatic (89%), irrespective of vaccination status, and 0.2% of vaccinated, and 0.3% of unvaccinated women required hospitalisation.
  • Vaccination-related side-effects were reported by 68 women, and none were considered severe, with the most reported including headache, general weakness, non-specified pain and stomach pain.
  • During the study period 2,814 women gave birth. Importantly, there were no significant differences in pregnancy outcomes between the two groups, including rates of preeclampsia, intrauterine growth restriction, infant birth weight, miscarriage and stillbirth.

Because testing was done on an as-need basis, the study may have overlooked participants with asymptomatic illness. Additionally, participants were followed from their first dose, thus it is likely efficacy would increase after the second.
 
Despite some limitations, and being an observational study, this paper evidences the effectiveness of the Pfizer vaccine for pregnant women, during a period where the delta variant was present in Israel and should provide reassurance for those considering vaccination during pregnancy.